Pickleball/Tennis Elbow | Recovery and Management
By Guest Blogger Priya Patel
Tennis elbow, also known as pickleball elbow, or more formally lateral epicondylitis, is caused by overuse of the wrist extensor muscles in the forearm, which connect to the elbow through the common extensor tendon. It is often seen with racquet sports, throwing sports, carpenters, plumbers, and butchers. Repetitive gripping or repetitive motions of the wrist cause irritation or inflammation of the tendon. This leads to pain at the side of the elbow, which often gets worse with more repetitive wrist motion and gripping such as holding a mug or turning a door knob; As a result, this often limits one’s ability to complete even everyday tasks, let alone the sport or activity that caused it. The good news is that most cases of lateral epicondylitis recover without need for surgery2,3. Physical therapy is very helpful in resolving the condition1. In addition, there are a few steps and exercises you can do at home to manage the pain and facilitate recovery. With that being said, let’s get to it so that you can get back to work, your hobbies, or even on the court (or wherever you like to play pickleball!).
Rest, ice, compression, and elevation (RICE) are beneficial for reducing the pain associated with tennis elbow1. However, rest does not mean to utterly avoid using your arm; instead, it’s about finding ways to modify activities so as to limit excessive movement in your wrist and provide comfort. Icing is especially helpful; 5-10 minutes should bring reprieve. Compression can also be used – either by wearing a supportive brace or bandage – to offer additional support and reduction of discomfort. Finally, while swelling isn’t usually a problem with this type of injury, if the elbow area is swollen then elevating it (above heart level) can help reduce the amount of fluid retention in that spot. While RICE is great for pain management, it is not a treatment for tennis elbow. In order for the tendon to heal, you must engage it with an appropriate amount of exercise.
Strengthening, stretching, and endurance exercises are all essential components of a rehabilitation plan for lateral epicondylitis.
Note that while I do give you the repetitions, these are general guidelines. If the pain becomes unbearable, then stop the activity. What is too much pain? Using a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you have ever felt — I suggest staying below a 5 rating. While physical therapy is associated with some discomfort and soreness, it should never lead to sharp, severe pain. On a similar note, if these strengthening exercises seem like a walk in the park, then it’s likely time to increase the weight, or add on extra repetitions. Remember, exercise and physical therapy lead to reduced pain overtime.
Wrist Extension and Flexion Stretch
Hold each position for 30 seconds and repeat 3 times. Keep your arm straight but don’t lock out your elbows. You can start with this stretch before doing the exercises below.
You can use a ball, or a towel. With your palm facing up, feel free to rest your forearm on a table. Squeeze for 5 seconds, and release. Repeat for 10 repetitions.
Eccentric Wrist Extensions with Weight
Start with light weight; I’m using a 1lb water bottle in the picture. Begin with your palm facing down and lift your palm towards the wall in front of you (top picture). Then lower it slowly over 3-5 seconds back to the palm facing down (bottom picture). Keep your elbows pinned to your side, or you can rest your bent elbow and forearm on a table with your hand off the table. Repeat for 10 repetitions.
Just like you are wringing water out of a towel, twist the towel with both hands in opposite directions. Repeat 20 times total (10 in each direction).
Dumbbell Pronation and Supination
Start with light weight; I’m using 1lb. Rest your 90 degree bent elbow and forearm on a table with your hand off the table. Holding the weight with your palm facing down towards the floor, turn your palm up towards the ceiling, and then back down to where you started. Repeat 10 times.
Looking forward, it’s important to be mindful of tennis elbow and how you prepare for activity. Take time to warm up before physical activities. Utilizing proper body mechanics during activity such as pivoting your body instead of just your arm while swinging a racquet. Additionally, using proper equipment is key; For example, choosing a racquet that is right for you can help reduce your risk of injury. Most of all, stay consistent with your wrist extensor strengthening exercises and stretches.
Ultimately, combining pain management (RICE) with an appropriate amount of exercise is an effective way to recover from lateral epicondylitis. These exercises are a great starting point to help manage your lateral epicondylitis, but I encourage you to speak with a medical professional for more tailored advice and treatment plans. It is always important to consult a doctor before beginning any exercise program – this way you can ensure that any serious injury such as a muscle or tendon tear is ruled out, and only activities appropriate for your condition are recommended.
Disclaimer: Please consult your physician or health professional before engaging in any physical activity and stop if you experience pain or discomfort.
About Priya Patel
Priya holds a Bachelor of Science in exercise science from the University of Delaware. As a Certified Personal Trainer, Nutritional Specialist, and more importantly – a lifelong health nerd – she loves anything fitness, nutrition, and wellness related.
As a DPT graduate student at the University of Delaware, she continues her education and learns even more about how to optimize human function and rehabilitation. When she isn’t prepping for her upcoming exam, doing clinicals, and diving into research projects, you can find her creating applicable content for her health blog. In the end, she hopes to instill in you the importance of making both your mental and physical health a priority, and empower you to live your best life.In her spare time, she enjoys spending time with friends and family, reading, traveling, working-out, and occasionally binge watching Friends.
- Anderson MK, Hall SJ, Martin. Fundamentals of Sports Injury Management. Fourth Edition. Lippincott Williams & Wilkins. 2009.
- Landesa-Piñeiro, L., & Leirós-Rodríguez, R. (2022). Physiotherapy treatment of lateral epicondylitis: A systematic review. Journal of back and musculoskeletal rehabilitation, 35(3), 463–477. https://doi.org/10.3233/BMR-210053
- Sueki D, Brechter J. Orthopedic Rehabilitation Clinical Advisor. Mosby Inc. 2010